This is a blog by a former CEO of a large Boston hospital to share thoughts about hospitals, medicine, and health care issues.

Wednesday, November 08, 2006

$8.60

That's the average annual investment per American in cancer research, in federal funding through the National Institutes of Health. The total federal investment per American in cancer research over the last 30 years is about $260.

What has this produced? Thirty years ago, when people were afraid to even mention "the Big C", we were only able to detect large, advanced tumors. There was virtually no early detection. Survival times were short. Only one child in 10 survived cancer. Treatment was highly uncertain and painful and required long hospital stays.

Today, for the first time, annual cancer deaths in the United States have fallen. There are ten million cancer survivors. Early detection and screening are more effective. New targeted, minimally invasive treatments have multiplied. New discoveries make it possible for the first time to "personalize" cancer treatment.

7 comments:

I wonder how much more the experts in the field think could be spent wisely. Perhaps some incremental resources could be freed up if we cut back on futile care at the end of life, including hopeless Stage 4 cancer cases. I also think it would be helpful if CMS were specifically authorized by Congress to consider cost relative to benefits in deciding whether or not to pay for some of the new ultra expensive biotech cancer treatments that are coming to market. Many people in medicine seem reluctant to accept the fact that resources are finite. As a taxpayer, I find that mentality frustrating and counterproductive.

I believe that as people find more and more employers either dropping healthcare coverage altogether or shifting more of the cost to employees, attitudes will likely change. Also, as the cost of both Medicare and Medicaid continue to escalate far in excess of inflation and population growth, either much higher taxes will be required or more worthy public priorities will be crowded out. The bottom line is that the system is unsustainable, and I don't think just bashing drug companies and insurers and squeezing providers (the essence of the single payer argument) is the answer. It would be nice to see hospitals and doctors offer some ideas to fix this that might cost them some money in the short term but would result in a better system over the long term that the society could afford and sustain.

I am not sure what ideas you expect doctors and hospitals to offer -- beyond trying to provide high quality care and do so efficiently. The broad societal issue is very complex. Here in MA, several months of debate and discussion led to a new approach to health care. Doctors and hositals were intimately involved in the talks that led to that legislation.

There are a number of ideas for reducing healthcare costs that I think hospitals and doctors could / should support. They are:

1. Lobby to convince the Congress that CMS needs to provide leadership with respect to care at the end of life. This includes specific authorization to consider cost in determining what treatments will and will not be paid for. Of course, lower healthcare utilization means less revenue for hospitals, doctors and other providers.

2. Insurers and employers could be lobbied to support streamlining of insurance offerings. This means paying a given provider the same price for the same covered service no matter which of the insurer's offerings the patient has and no matter what company he or she works for. Such streamlining could materially lower administrative costs within doctors' offices and, to a lesser extent, within hospitals.

3. The medical community should embrace price and quality transparency. Confidentiality agreements that stand in the way of transparency should be eliminated.

4. Doctors and hospitals could lobby, at least at the state level, for specialized health courts to hear medical disputes instead of the current wildly unpredictable jury system. I think there is also plenty of room for improvement in getting the worst doctors out of medicine.

5. Hospitals could work to convince the Congress that some up front investment in interoperable electronic medical records could reduce both costs and medical errors, especially in hospitals.

6. All medical providers need to push both the federal and state governments to do a better job of combating fraud.

The bottom line is that there is too much debate about how to pay for medical care (taxpayer funding, employer provided care, consumerism, etc.) and not nearly enough on how to reduce utilization without sacrificing quality.

Thirty years ago, individuals with my type of cancer (aggressive lymphoma) almost always died within a year. So I think I've gotten my $8.60 worth! ;)

Now let's see some similar resources applied to cancer survivorship and its long-term health implications. It's been a whole year since the Institute of Medicine came out with its report on "Lost in Transition." I'd be interested in knowing whether BID - or any other hospitals, for that matter - are doing anything to improve the level of care for survivors.